First Insights into Cryoballoon-based Pulmonary Vein Isolation Taking the Individual Time-to-isolation into Account

Aims: Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an established treatment for symptomatic atrial fibrillation (AF). In the present study, we sought to assess the efficacy and safety of CB-based PVI taking the individual time-to-isolation (TTI) into account.

Methods And Results: Sixty consecutive patients with drug-refractory paroxysmal atrial fibrillation [n = 49 (82%)] or short-standing persistent atrial fibrillation [n = 11 (18%)] underwent ablation with a 28-mm second-generation CB. The TTI was assessed by spiral mapping-catheter recordings and subsequently followed by an additional freeze-time of 120 s. No bonus freeze-cycle was applied. If the TTI could not be assessed, a fixed freeze-cycle duration of 240 s was applied and successful PVI confirmed thereafter. Clinical follow-up (FU) included 12-lead ECGs and 24 h Holter-ECGs at 3, 6, and 12 months. A blanking period of 3 months was defined. A total of 239 pulmonary veins (PVs) were identified and successfully isolated. The mean TTI assessed in 170/239 (71%) PVs was 52 ± 32 s. The mean number of CB applications was 1.2 ± 0.5; mean freeze-cycle duration was 192 ± 41 s. Mean procedure and fluoroscopy times were 80 ± 24 min and 16 ± 7 min, respectively. Transient phrenic nerve palsy occurred in one patient (2%). During a mean FU of 405 ± 67 days, 43 patients (72%) remained in stable sinus rhythm.

Conclusions: Integrating an individual TTI protocol to CB-based PVI results in shorter freeze-cycle applications in a substantial portion of targeted PVs and an arrhythmia-free survival comparable to conventional ablation protocols. The complication rate is low.